by Melissa Chan, Physiotherapist
Breathlessness, or being short of breath (SOB), is one of the most common symptoms of PH. Here are some ways that may help you manage it:
Breathing Techniques
Firstly, let’s review what the diaphragm looks like. It is our main muscle of breathing. You will not be able to feel the diaphragm directly, but you can feel it pushing your belly out when it contracts.
1. Diaphragmatic Breathing or Breathing Control (Normal breathing)
Sit or lie in a relaxed position. Place your hand just above your belly button. Breathe in : feel your belly coming out and your hand rising. Breathe out: feel your belly relaxing and your hand coming back down. Do not restrict your chest from moving. It should rise and fall normally, but we want the diaphragm to lead the way.
When should I do this?
Do this when you are at rest. Practise regularly to ensure your diaphragm is moving well. After you master your diaphragm, you may be able to control breathlessness during physical exertion.
How many times should I do this?
You can practise this for as long as you want. I would recommend this at least once a day for a minimum of 10 minutes. However, the more you practise, the better you’ll get at using your diaphragm to breathe.
I am starting to feel slightly uncomfortable. Is this normal?
After a few breaths, you may start to feel uncomfortable, like you need to take in a deep breath. This is completely normal, as your body is telling you it needs to reset carbon dioxide levels. Take a deep breath in and out, then resume practice.
Do I breathe with my nose or my mouth?
I would recommend breathing in and out through your nose if you can. Nose breathing tends to activate your diaphragm better. However, it can feel slightly uncomfortable the first few times if you are not used to it. You can also try breathing in through your nose and out through your mouth. Do whatever feels comfortable for you.
2. Deep Breathing (Thoracic Expansion Exercise, with or without breath hold)
Use the same technique as Diaphragmatic Breathing, but take in a larger breath. Feel the sides of your ribcage expanding as you draw air all the way down to your belly. Try breathing out for at least 3 seconds. Practise this up to 5 times at one go.
For added benefit, hold your breath after you breathe in. Count up to 3. Release the breath. Add this step only if you feel comfortable.
When should I do this?
Practise this at rest, when you expect to become breathless (such as physical activity), or when you are already breathless.
Can I do more than 5 at one go?
Large amounts of air going in and out of your lungs can cause carbon dioxide levels to fall. You may start to feel lightheaded or faint. Do more breaths at one go only if you are very confident and sure that you will not feel faint.
3. Pacing
Time your breath to the activity that makes you breathless. For example, as you climb stairs:
One breath in = one step
One breath out = three steps
Find a rhythm that feels comfortable for you for that activity.
Another method is to inhale as you prepare for a physical movement. As you breathe out, perform that movement. For example:
Breathe in to prepare
Breathe out as you stand up from the chair
How do these techniques help?
Gas exchange refers to the process where carbon dioxide leaves the blood, while oxygen enters. This takes place in the lungs and will become affected by PH. By slowing down the movement, we are allowing the lungs time to catch up with the demands of the activity.
4. Purse-lip Breathing
This technique forces you to slow down your breathing. Breathe in gently through the nose. Purse your lips and breathe out, according to the picture. Your tummy should be relaxed.
When should I do this?
Do this technique when you expect to feel breathless, such as during physical activity. You may also combine it with Normal Breathing or Deep Breathing to make it more effective.
Positioning
With positioning, we aim to put the diaphragm in positions that allow it to contract most easily. This reduces the effort needed for each breath and may allow you to feel less breathless. The following are some positions that may help:
Try getting into these positions and practise breathing techniques when you feel breathless.
Other Strategies
Slow Down
Slowing down your movements allows time for your body to keep up with the activity. Even though you may feel it is better to ‘get it over and done with’, you may take a longer time to recover from the breathlessness. Try pacing your activity with your breathing. It may take slightly longer but you may not need as much time to recover from breathlessness.
Supplemental Oxygen
If your doctor has prescribed supplemental oxygen, you may use it when you are doing activities that make you breathless. Remember to breathe in through your nose so that you can get the maximum benefit from the oxygen (if using nasal prongs). Also make sure that your supplemental oxygen system is well-humidified with the attached water chamber.
Moving Air
There are receptors in your face that sense when air is moving. It tells the brain that there is enough air available. Some people have described feeling less breathless when there is airflow to their face. Try sitting in front of a clean fan, or stand by a breezy window when you feel breathless.
Regular Exercise
Since physical activity requires effort, it is common for people with PH to avoid activity altogether. However, this leads to a vicious cycle of inactivity and breathlessness. Regular exercise ensures that your lungs, muscles, and blood circulation are working as best as they can.
Try Not To Panic
It feels scary to be breathless. But quick, shallow breaths will make it worse and may even cause you to faint. Focus on Deep Breathing exercises and try a combination of techniques above. If you are often anxious, try seeing a psychologist or therapist who can help you manage your emotions.
When To Seek Help
It is important that you recognise when you are becoming too breathless and have other symptoms, such as a drop in oxygen saturation. Discuss with your doctor or nurse on an action plan that states clearly what you should do when you have certain symptoms. For example:
- Being more than 5/10 breathless that does not get better with rest
- Drop in oxygen saturation of 5% or more from your usual level, which does not get better with rest
- Other new physical symptoms such as chest pain or tightness
- Signs of infection, such as fever, cough with phlegm
Depending on the severity of the symptoms, the action may range from calling your doctor/nurse, or going to the A&E. Make sure that the action plan is also available to your caregiver or family.